Outpatient end of life discussions shorten hospital admissions in gynecologic oncology patients

Objective. The study goal was to determine whether prior outpatient exposure to hospice discussion altered the inpatient Course and end-of-life (EOL) care among patients ultimately discharged to hospice. Methods. Medical records from January 2009 to June 2012 were reviewed and data were abstracted under an IRE-approved protocol. Hospice discussions were identified in the last outpatient clinical encounter prior to admission. Kaplan-Meier was used to estimate overall survival (OS) and the log-rank test was used to test for differences. Results. There were 89 hospitalizations resulting in discharge to hospice care: 41 women with ovarian (46%), 23 with uterine (29%), 19 with cervical (21.3%), and with 6 vulvar/vaginal (6.7%) cancers. 83 patients (93%) had outpatient clinical encounters prior to admission;18% (15/83) were exposed to a hospice discussion (HD) and 82% (68/83) were not (NHD). Median time from last outpatient encounter was 18 days (range 0-371). NHD patients had longer inpatient length of stay (median 7 days vs. 4 days, p = 0.008) and were less likely to receive palliative care consults than the HD patients. (65% vs. 93%, p = 0.03). Median OS for HD patients was 33 days (95% CI 22 d-61 d) vs. 60 days (95% CI 49 0,44 d) for NHD patients (p = 0.01). There were no differences detected based on race, ethnicity, or insurance status. Conclusions. HD patients had significantly shorter OS suggesting that providers were accurate in identifying patients nearing the EOL. Patients exposed to outpatient hospice discussions had a shorter length of stay and increased utilization of palliative care resources. (C) 2013 Elsevier Inc. All rights reserved.